Department of Dermatology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
J Dermatolog Treat. 2011 Apr;22(2):86-9. doi: 10.3109/09546630903578582. Epub 2010 Aug 1.
Acitretin is a time-honored treatment for psoriasis. During the last decade biologics have revolutionized the treatment of psoriasis. This raises the question: What is the position of acitretin as a classical systemic treatment for psoriasis in the era of biologics? Based on the mode of action of acitretin, it is evident that at least one antipsoriatic treatment has to be available in the armamentarium of antipsoriatic treatments that is not immunosuppressive, intended for those patients who are contraindicated for immunosuppressive treatment. It is attractive to speculate that at least an additive or possibly a synergistic effect can be expected in case of combination of acitretin with a biologic. The efficacy of acitretin in chronic plaque psoriasis as a monotherapy is below methotrexate and cyclosporine. However, acitretin in combination with phototherapy has an efficacy at least comparable with the other classical systemic treatments. Based on several clinical studies it can be concluded that acitretin is an important treatment option in case of contraindications for immunosuppression, such as patients with infections or cancer-prone patients. Furthermore, some evidence is available for high efficacy of the combination of acitretin and biologics.
阿维 A 酯是一种历史悠久的银屑病治疗药物。在过去的十年中，生物制剂彻底改变了银屑病的治疗方法。这就提出了一个问题：在生物制剂时代，阿维 A 酯作为一种经典的全身性银屑病治疗药物的地位如何？基于阿维 A 酯的作用模式，显然在抗银屑病治疗的武器库中至少有一种非免疫抑制性的抗银屑病药物，适用于那些不适合免疫抑制治疗的患者。推测阿维 A 酯与生物制剂联合使用时，至少可以预期有相加或协同作用，这是很有吸引力的。阿维 A 酯作为单一药物治疗慢性斑块型银屑病的疗效低于甲氨蝶呤和环孢素。然而，阿维 A 酯联合光疗的疗效至少与其他经典的系统治疗相当。基于几项临床研究，可以得出结论，在存在免疫抑制禁忌的情况下，如感染或易患癌症的患者，阿维 A 酯是一种重要的治疗选择。此外，还存在阿维 A 酯与生物制剂联合使用具有高疗效的证据。
